Rhinorrhea describe a condition in which cerebrospinal fluid leaks out of the nose. It may also leak down the throat. Disruptions of the base of the skull, with loss of integrity of the dura, may produce rhinorrhea. Occasionally tumors will destroy portions of the skull that will allow spinal fluid to drain out. Surgical procedures in the nasal cavity and sinuses may occasionally damage the skull and dura enough to produce spinal fluid leaks. Many case of rhinorrhea secondary to trauma will heal themselves. Occasionally, persistent spinal fluid leaks will occur that require some type of surgical intervention to stop them. Complications of rhinorrhea include infections, the most common one being meningitis.
Causes of Rhinorrhea
Rhinorrhea most commonly occurs from disruption of the skull in the anterior fossa. This region, located behind and above the eyes, is readily damage by basilar skull fractures. The olfactory nerves, which permit smell, are commonly damaged in injuries that produce rhinorrhea. Trauma to the petrous bone, where the hearing and balance apparatus are housed, can also lead to rhinorrhea. In these cases, cerebrospinal fluid drains into the middle ear. It drains down the Eustachian tube to the nasal cavity. The Eustachian tube allows for equilibration of pressure between the atmosphere and the middle ear cavity. Occasionally tumors will destroy a portion of the skull base and dura and produce rhinorrhea. Sinus surgery, with inadvertent disruption of the dura can also produce rhinorrhea.
Signs and Symptoms of Rhinorrhea
Crystal clear fluid running out of the nose, particularly when the head is held in a dependent position, if the cardinal sign of rhinorrhea. Occasionally, nasal fluid may be copious. The nasal fluid, however, does not have glucose in it. This can help differentiate the etiology of the fluid. Headache can occur as cerebrospinal fluid drains out. Sufficient air can enter the skull to distort the brain and produce pneumocephalus. If bacteria enter the brain, meningitis may develop. This is heralded by the onset of increasingly severe headache, fever, stiff neck, nausea and vomiting. Seizure may occur.
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Medical Content Last Updated on 07/12/2008
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